Transcatheter Aortic Valve Implantation for Severe Chronic Aortic Regurgitation

TL;DR

This paper reviews the use of a less invasive heart valve implantation technique for a specific heart condition where it is not commonly used.

Contribution

The paper provides a review of current evidence and challenges for using TAVI in pure aortic regurgitation.

Findings

TAVI is less established for aortic regurgitation compared to aortic stenosis.

Anatomical differences in aortic regurgitation patients pose challenges for TAVI.

Valve migration and leaks are higher risks in aortic regurgitation cases.

Abstract

Transcatheter aortic valve implantation (TAVI) has revolutionised the management of aortic valve disease, offering a less invasive alternative to traditional surgical valve replacement for severe aortic stenosis (AS). TAVI for pure aortic regurgitation (AR) is less well established, and, in fact, it was previously labelled as a relative contraindication. However, TAVI has been utilised for selected cases of pure or predominant AR. The primary limitations regarding the use of TAVI in AR are related to the absence of anatomical factors seen in patients with AS that have contributed to the safe and stable functioning of current-generation prostheses. These include aortic root dilatation, mobile valve leaflets and labile blood pressure within the aortic root, which may further increase the risk of valve migration and periprosthetic leak after deployment. Furthermore, patients with AR have more heterogeneous aortic root anatomies when compared to the population of patients with calcific or degenerative AS. This review article describes the current evidence for the off-label use of TAVI in pure AR and the various clinical syndromes associated with AR where there may be specific challenges in the application of TAVI.

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